WO2022219503A1

WO2022219503A1 - Utilizing contextual parameters of one or more surgical devices to predict a frequency interval for displaying surgical information

Info

Publication number: WO2022219503A1
Application number: PCT/IB2022/053378
Authority: WO
Inventors: Iv Frederick E. Shelton; Jacqueline C. ARONHALT; Matthew D. COWPERTHWAIT; Cory G. Kimball; Monica L.Z. Rivard; Leonardo N. Rossoni; Risto KOJCEV; Felix J. BORK; Jason L. Harris; Matthew J. THIEL; Ryan W. McGhee; Tylor C. MUHLENKAMP; Matjaz JOGAN
Original assignee: Cilag Gmbh International
Priority date: 2021-04-14
Filing date: 2022-04-11
Publication date: 2022-10-20
Also published as: CN117441362A; JP2024514637A; CN117501378A; EP4136652A1; EP4128854A1; WO2022219497A1; BR112023021464A2; JP2024514882A; EP4136646A1; WO2022219499A1; US20220336097A1; BR112023021249A2; JP2024514881A; BR112023021240A2; EP4136650A1; JP2024514633A; US20220331050A1; US20220336078A1; US20220331054A1; US20220331056A1

Abstract

A system, method, and device for displaying relevant augmented reality (AR) content to a surgical staff members without over-saturating the augmented display with virtual elements. The surgical staff members (e.g., doctors, nurses, surgeons, technicians, etc.) require AR content that is delicately balanced between displaying helpful information without distracting the surgeon. A surgical hub receives a plurality of inputs related to surgical environment and displays only necessary information to allow the surgeon to provide effective care to the patient, based on a determined trigger event.

Description

TITLE

UTILIZING CONTEXTUAL PARAMETERS OF ONE OR MORE SURGICAL DEVICES TO PREDICT A FREQUENCY INTERVAL FOR DISPLAYING SURGICAL INFORMATION

CROSS-REFERENCE TO RELATED APPLICATIONS [0001] This application claims the benefit under 35 U.S.C. § 119(e) to U.S. Provisional Patent Application No. 63/174,674, titled HEADS UP DISPLAY, filed April 14, 2021 and to U.S. Provisional Patent Application No. 63/284,326, titled INTRAOPERATIVE DISPLAY FOR SURGICAL SYSTEMS, filed November 30, 2021 , the disclosure of each of which is herein incorporated by reference in its entirety.

BACKGROUND

[0002] This disclosure relates to apparatuses, systems, and methods for providing an augmented reality interactive experience during a surgical procedure. During a surgical procedure it would be desirable to provide an augmented reality interactive experience of a real- world environment where objects that reside in the real world are enhanced by overlaying computer-generated perceptual information, sometimes across multiple sensory modalities, including visual, auditory, haptic, somatosensory, and olfactory. In the context of this disclosure, images of a surgical field and surgical instruments and other objects appearing in the surgical field are enhanced by overlaying computer-generated visual, auditory, haptic, somatosensory, olfactory, or other sensory information onto the real world images of the surgical field and instruments or other objects appearing in the surgical field. The images may be streamed in real time or may be still images.

[0003] Real world surgical instruments include a variety of surgical devices including energy, staplers, or combined energy and stapler. Energy based medical devices include, without limitation, radio-frequency (RF) based monopolar and bipolar electrosurgical instruments, ultrasonic surgical instruments, combination RF electrosurgical and ultrasonic instruments, combination RF electrosurgical and mechanical staplers, among others. Surgical stapler devices are surgical instruments used to cut and staple tissue in a variety of surgical procedures, including bariatric, thoracic, colorectal, gynecologic, urologic and general surgery.

SUMMARY

[0004] In various instances, the present disclosure provides a surgical system comprises: a remote server; augmented reality (AR) output device; one or more surgical devices; a surgical hub communicatively coupled to the remote server, the one or more surgical devices, and the AR output device, the surgical hub comprises a control circuit coupled to a memory, and wherein the control circuit is configured to: determine contextual parameters from a surgical environment; determine from the contextual parameter a specific surgical procedure being performed in an operating room; receive procedural data from the remote server, wherein the procedural data indicates steps and surgical instruments associated with the specific surgical procedure; determine that a trigger event is anticipated based on the procedural data and the contextual parameters; initiate a response to the anticipated trigger event according to the surgical instruments and procedural data.

[0005] In various instances, the present disclosure provides a method for managing surgical device interaction during a surgical procedure, the method comprising: determining, by a surgical hub, contextual parameters from a surgical environment; determining, by the surgical hub, a specific surgical procedure being performed in an operating room based on the contextual parameters; receiving, by the surgical hub, procedural data from a remote server, wherein the procedural data indicates steps and surgical instruments associated with the specific surgical procedure; determining, by the surgical hub, that a trigger event is anticipated based on the procedural data and the contextual parameters; and initiating, by the surgical hub, a response according to the surgical instruments and the procedural data.

FIGURES

[0006] The various aspects described herein, both as to organization and methods of operation, together with further objects and advantages thereof, may best be understood by reference to the following description, taken in conjunction with the accompanying drawings as follows.

[0007] FIG. 1 is a block diagram of a computer-implemented interactive surgical system, according to one aspect of this disclosure.

[0008] FIG. 2 is a surgical system being used to perform a surgical procedure in an operating room, according to one aspect of this disclosure.

[0009] FIG. 3 is a surgical hub paired with a visualization system, a robotic system, and an intelligent instrument, according to one aspect of this disclosure.

[0010] FIG. 4 illustrates a surgical data network comprising a modular communication hub configured to connect modular devices located in one or more operating theaters of a healthcare facility, or any room in a healthcare facility specially equipped for surgical operations, to the cloud, according to one aspect of this disclosure. [0011] FIG. 5 illustrates a computer-implemented interactive surgical system, according to one aspect of this disclosure.

[0012] FIG. 6 illustrates a surgical hub comprising a plurality of modules coupled to the modular control tower, according to one aspect of this disclosure.

[0013] FIG. 7 illustrates an augmented reality (AR) system comprising an intermediate signal combiner positioned in the communication path between an imaging module and a surgical hub display, according to one aspect of this disclosure.

[0014] FIG. 8 illustrates an augmented reality (AR) system comprising an intermediate signal combiner positioned in the communication path between an imaging module and a surgical hub display, according to one aspect of this disclosure.

[0015] FIG. 9 illustrates an augmented reality (AR) device worn by a surgeon to communicate data to the surgical hub, according to one aspect of this disclosure.

[0016] FIG. 10 illustrates a system for augmenting surgical instrument information using an augmented reality display, according to one aspect of this disclosure.

[0017] FIG. 11 illustrates a timeline of a situational awareness surgical procedure, according to one aspect of this disclosure.

[0018] FIG. 12 shows a graphical representation of frequency shifting response by a surgical hub to anticipated signal interference, according to one aspect of this disclosure.

[0019] FIG. 13 shows a timeline of device activation and communication transmissions scheduled by a surgical hub, according to one aspect of this disclosure.

[0020] FIG. 14 shows a flow diagram to evaluate a plurality of factors and determine a hierarchy of communication and device activation, according to one aspect of this disclosure. [0021] FIG. 15 shows a graphical representation of an end effector signal and noise, when the end effector clamps onto tissue and is in the process of firing, according to one aspect of this disclosure.

[0022] FIG. 16 shows a flow diagram of surgical hub responses based on the anticipation or detection of a trigger event, according to one aspect of this disclosure.

[0023] FIG. 17 shows a system for managing surgical device interaction during a surgical procedure, according to one aspect of this disclosure.

[0024] FIG. 18 is a logic diagram of a method for managing surgical device interaction during a surgical procedure, according to one aspect of this disclosure.

[0025] Corresponding reference characters indicate corresponding parts throughout the several views. The exemplifications set out herein illustrate various disclosed embodiments, in one form, and such exemplifications are not to be construed as limiting the scope thereof in any manner.

DESCRIPTION

[0026] Applicant of the present application owns the following U.S. Patent Applications filed concurrently herewith, the disclosures of each of which is herein incorporated by reference in its entirety:

• U.S. Patent Application, titled METHOD FOR INTRAOPERATIVE DISPLAY FOR SURGICAL SYSTEMS; Attorney Docket No. END9352USNP1/210120-1 M;

• U.S. Patent Application, titled Utilization of surgical data values and situational awareness to control the overlay in surgical field view; Attorney Docket No. END9352USNP2/210120-2;

• U.S. Patent Application, titled SELECTIVE AND ADJUSTABLE MIXED REALITY OVERLAY IN SURGICAL FIELD VIEW; Attorney Docket No. END9352USNP3/210120- 3;

• U.S. Patent Application, titled RISK BASED PRIORITIZATION OF DISPLAY ASPECTS IN SURGICAL FIELD VIEW; Attorney Docket No. END9352USNP4/210120-4;

• U.S. Patent Application, titled SYSTEMS AND METHODS FOR CONTROLLING SURGICAL DATA OVERLAY; Attorney Docket No. END9352USNP5/210120-5;

• U.S. Patent Application, titled SYSTEMS AND METHODS FOR CHANGING DISPLAY OVERLAY OF SURGICAL FIELD VIEW BASED ON TRIGGERING EVENTS; Attorney Docket No. END9352USNP6/210120-6;

• U.S. Patent Application, titled CUSTOMIZATION OF OVERLAID DATA AND CONFIGURATION; Attorney Docket No. END9352USNP7/210120-7;

• U.S. Patent Application, titled INDICATION OF THE COUPLE PAIR OF REMOTE CONTROLS WITH REMOTE DEVICES FUNCTIONS; Attorney Docket No. END9352USNP8/210120-8;

• U.S. Patent Application, titled COOPERATIVE OVERLAYS OF INTERACTING INSTRUMENTS WHICH RESULT IN BOTH OVERLAYS BEING EFFECTED; Attorney Docket No. END9352USNP9/210120-9;

• U.S. Patent Application, titled ANTICIPATION OF INTERACTIVE UTILIZATION OF COMMON DATA OVERLAYS BY DIFFERENT USERS; Attorney Docket No. END9352USNP10/210120-10;

• U.S. Patent Application, titled MIXING DIRECTLY VISUALIZED WITH RENDERED ELEMENTS TO DISPLAY BLENDED ELEMENTS AND ACTIONS HAPPENING ON SCREEN AND OFF-SCREEN; Attorney Docket No. END9352USNP11/210120-11 ; • U.S. Patent Application, titled SYSTEM AND METHOD FOR TRACKING A PORTION OF THE USER AS A PROXY FOR NON-MONITORED INSTRUMENT; Attorney Docket No. END9352USNP12/210120-12;

• U.S. Patent Application, titled COOPERATION AMONG MULTIPLE DISPLAY SYSTEMS TO PROVIDE A HEALTHCARE USER CUSTOMIZED INFORMATION; Attorney Docket No. END9352USNP14/210120-14;

• U.S. Patent Application, titled INTRAOPERATIVE DISPLAY FOR SURGICAL SYSTEMS; Attorney Docket No. END9352USNP15/210120-15;

• U.S. Patent Application, titled ADAPTATION AND ADJUSTABILITY OR OVERLAID INSTRUMENT INFORMATION FOR SURGICAL SYSTEMS; Attorney Docket No. END9352USNP16/210120-16; and

• U.S. Patent Application, titled MIXED REALITY FEEDBACK SYSTEMS THAT COOPERATE TO INCREASE EFFICIENT PERCEPTION OF COMPLEX DATA FEEDS; Attorney Docket No. END9352USNP17/210120-17.

[0027] Applicant of the present application owns the following U.S. Patent Applications, the disclosure of each of which is herein incorporated by reference in its entirety:

• U.S. Patent Application No. 16/209,423, titled METHOD OF COMPRESSING TISSUE WITHIN A STAPLING DEVICE AND SIMULTANEOUSLY DISPLAYING THE LOCATION OF THE TISSUE WITHIN THE JAWS, now U.S. Patent Publication No. US- 2019-0200981 -A1 ;

• U.S. Patent Application No. 16/209,453, titled METHOD FOR CONTROLLING SMART ENERGY DEVICES, now U.S. Patent Publication No. US-2019-0201046-A1 .

[0028] Before explaining various aspects of surgical devices and generators in detail, it should be noted that the illustrative examples are not limited in application or use to the details of construction and arrangement of parts illustrated in the accompanying drawings and description. The illustrative examples may be implemented or incorporated in other aspects, variations and modifications, and may be practiced or carried out in various ways. Further, unless otherwise indicated, the terms and expressions employed herein have been chosen for the purpose of describing the illustrative examples for the convenience of the reader and are not for the purpose of limitation thereof. Also, it will be appreciated that one or more of the following- described aspects, expressions of aspects, and/or examples, can be combined with any one or more of the other following-described aspects, expressions of aspects and/or examples.

[0029] Various aspects are directed to onscreen displays for surgical systems for a variety of energy and surgical stapler based medical devices. Energy based medical devices include, without limitation, radio-frequency (RF) based monopolar and bipolar electrosurgical instruments, ultrasonic surgical instruments, combination RF electrosurgical and ultrasonic instruments, combination RF electrosurgical and mechanical staplers, among others. Surgical stapler devices include and combined surgical staplers with electrosurgical and / or ultrasonic devices. Aspects of the ultrasonic surgical devices can be configured for transecting and / or coagulating tissue during surgical procedures, for example. Aspects of the electrosurgical devices can be configured for transecting, coagulating, sealing, welding and / or desiccating tissue during surgical procedures, for example. Aspects of the surgical stapler devices can be configured for transecting and stapling tissue during surgical procedures and in some aspects, the surgical stapler devices may be configured to delivery RF energy to the tissue during surgical procedures. Electrosurgical devices are configured to deliver therapeutic and / or nontherapeutic RF energy to the tissue. Elements of surgical staplers, electrosurgical, and ultrasonic devices may be used in combination in a single surgical instrument.

[0030] In various aspects, the present disclosure provides onscreen displays of real time information to the OR team during a surgical procedure. In accordance with various aspects of the present disclosure, many new and unique onscreen displays are provided to display onscreen a variety of visual information feedback to the OR team. According to the present disclosure, visual information may comprise one or more than one of various visual media with or without sound. Generally, visual information comprises still photography, motion picture photography, video or audio recording, graphic arts, visual aids, models, display, visual presentation services, and the support processes. The visual information can be communicated on any number of display options such as the primary OR screen, the energy or surgical stapler device itself, a tablet, augmented reality glasses, among others, for example.

[0031] In various aspects, the present disclosure provides a large list of potential options to communicate visual information in real time to the OR team, without overwhelming the OR team with too much visual information. For example, in various aspects, the present disclosure provides onscreen displays of visual information to enable the surgeon, or other members of the OR team, to selectively activate onscreen displays such as icons surrounding the screen option to manage a wealth of visual information. One or a combination of factors can be used to determine the active display, these may include energy based (e.g., electrosurgical, ultrasonic) or mechanical based (e.g., staplers) surgical devices in use, the estimated risk associated with a given display, the experience level of the surgeon and the surgeons’ choice among other things. In other aspect, the visual information may comprises rich data overlaid or superimposed into the surgical field of view to manage the visual information. In various aspects described hereinbelow, comprise superimposed imagery that requires video analysis and tracking to properly overlay the data. Visual information data communicated in this manner, as opposed to static icons, may provide additional useful visual information in a more concise and easy to understand way to the OR team.

[0032] In various aspects, the present disclosure provides techniques for selectively activating onscreen displays such as icons surrounding the screen to manage visual information during a surgical procedure. In other aspects, the present disclosure provides techniques for determining the active display using one or a combination of factors. In various aspects, the techniques according to the resent disclosure may comprise selecting the energy based or mechanical based surgical device in use as the active display, estimating risk associated with a given display, utilizing the experience level of the surgeon or OR team making the selection, among other things.

[0033] In other aspects, the techniques according to the present disclosure may comprise overlaying or superimposing rich data onto the surgical field of view to manage the visual information. A number of the display arrangements described by the present disclosure involve overlaying various visual representations of surgical data onto a livestream of a surgical field. As used herein the term overlay comprises a translucent overlay, a partial overlay, and / or a moving overlay. Graphical overlays may be in the form of a transparent graphic, semitransparent graphic, or opaque graphic, or a combination of transparent, semitransparent, and opaque elements or effects. Moreover, the overlay can be positioned on, or at least partially on, or near an object in the surgical field such as, for example, an end effector and/or a critical surgical structure. Certain display arrangements may comprise a change in one or more display elements of an overlay including a change in color, size, shape, display time, display location, display frequency, highlighting, or a combination thereof, based on changes in display priority values. The graphical overlays are rendered on top of the active display monitor to convey important information quickly and efficiently to the OR team.

[0034] In other aspects, the techniques according to the present disclosure may comprise superimposing imagery that requires analyzing video and tracking for properly overlaying the visual information data. In other aspects, the techniques according to the present disclosure may comprise communicating rich visual information, as opposed to simple static icons, to provide additional visual information to the OR team in a more concise and easy to understand manner. In other aspects, the visual overlays may be used in combination with audible and / or somatosensory overlays such as thermal, chemical, and mechanical devices, and combinations thereof. [0035] The following description is directed generally to apparatuses, systems, and methods that provide an augmented reality (AR) interactive experience during a surgical procedure. In this context, images of a surgical field and surgical instruments and other objects appearing in the surgical field are enhanced by overlaying computer-generated visual, auditory, haptic, somatosensory, olfactory, or other sensory information onto the real world images of the surgical field, instruments, and/or other objects appearing in the surgical field. The images may be streamed in real time or may be still images. Augmented reality is a technology for rendering and displaying virtual or “augmented” virtual objects, data, or visual effects overlaid on a real environment. The real environment may include a surgical field. The virtual objects overlaid on the real environment may be represented as anchored or in a set position relative to one or more aspects of the real environment. In a non-limiting example, if a real world object exits the real environment field of view, a virtual object anchored to the real world object would also exit the augmented reality field of view.

[0036] A number of the display arrangements described by the present disclosure involve overlaying various visual representations of surgical data onto a livestream of a surgical field. As used herein the term overlaying comprises a translucent overlay, a partial overlay, and/or a moving overlay. Moreover, the overlay can be positioned on, or at least partially on, or near an object in the surgical field such as, for example, an end effector and/or a critical surgical structure. Certain display arrangements may comprise a change in one or more display elements of an overlay including a change in color, size, shape, display time, display location, display frequency, highlighting, or a combination thereof, based on changes in display priority values.

[0037] As described herein AR is an enhanced version of the real physical world that is achieved through the use of digital visual elements, sound, or other sensory stimuli delivered via technology. Virtual Reality (VR) is a computer-generated environment with scenes and objects that appear to be real, making the user feel they are immersed in their surroundings. This environment is perceived through a device known as a Virtual Reality headset or helmet. Mixed reality (MR) and AR are both considered immersive technologies, but they aren't the same. MR is an extension of Mixed reality that allows real and virtual elements to interact in an environment. While AR adds digital elements to a live view often by using a camera, an MR experience combines elements of both AR and VR, where real-world and digital objects interact. [0038] In an AR environment, one or more computer-generated virtual objects may be displayed along with one or more real (i.e. , so-called “real world”) elements. For example, a real-time image or video of a surrounding environment may be shown on a computer screen display with one or more overlaying virtual objects. Such virtual objects may provide complementary information relating to the environment or generally enhance a user's perception and engagement with the environment. Conversely, the real-time image or video of the surrounding environment may additionally or alternatively enhance a user's engagement with the virtual objects shown on the display.

[0039] The apparatuses, systems, and methods in the context of this disclosure enhance images received from one or more imaging devices during a surgical procedure. The imaging devices may include a variety of scopes used during non-invasive and minimally invasive surgical procedures, an AR device, and/or a camera to provide images during open surgical procedures. The images may be streamed in real time or may be still images. The apparatuses, systems, and methods provide an augmented reality interactive experience by enhancing images of the real world surgical environment by overlaying virtual objects or representations of data and/or real objects onto the real surgical environment. The augmented reality experience may be viewed on a display and/or an AR device that allows a user to view the overlaid virtual objects onto the real world surgical environment. The display may be located in the operating room or remote from the operating room. AR devices are worn on the head of the surgeon or other operating room personnel and typically include two stereo-display lenses or screens, including one for each eye of the user. Natural light is permitted to pass through the two transparent or semi-transparent display lenses such that aspects of the real environment are visible while also projecting light to make virtual objects visible to the user of the AR device. [0040] Two or more displays and AR devices may be used in a coordinated manner, for example with a first display or AR device controlling one or more additional displays or AR devices in a system with defined roles. For example, when activating display or an AR device, a user may select a role (e.g., surgeon, surgical assistant, nurse, etc., during a surgical procedure) and the display or AR device may display information relevant to that role. For example, a surgical assistant may have a virtual representation of an instrument displayed that the surgeon needs to perform for a next step of a surgical procedure. A surgeon’s focus on the current step may see different information displayed than the surgical assistant.

[0041] Although there are many known onscreen displays and alerts, this disclosure provides many new and unique augmented reality interactive experiences during a surgical procedure. Such augmented reality interactive experiences include visual, auditory, haptic, somatosensory, olfactory, or other sensory feedback information to the surgical team inside or outside the operating room. The virtual feedback information overlaid onto the real world surgical environment may be provided to an operating room (OR) team, including personnel inside the OR including, without limitation, the operating surgeon, assistants to the surgeon, a scrub person, an anesthesiologist and a circulating nurse, among others, for example. The virtual feedback information can be communicated on any number of display options such as a primary OR screen display, an AR device, the energy or surgical stapler instrument, a tablet, augmented reality glasses, device etc.

[0042] FIG. 1 depicts a computer-implemented interactive surgical system 1 that includes one or more surgical systems 2 and a cloud-based system 4. The cloud-based system 4 may include a remote server 13 coupled to a storage device 5. Each surgical system 2 includes at least one surgical hub 6 in communication with the cloud 4. For example, the surgical system 2 may include a visualization system 8, a robotic system 10, and handheld intelligent surgical instruments 12, each configured to communicate with one another and/or the hub 6. In some aspects, a surgical system 2 may include an M number of hubs 6, an N number of visualization systems 8, an O number of robotic systems 10, and a P number of handheld intelligent surgical instruments 12, where M, N, O, and P are integers greater than or equal to one. The computer- implemented interactive surgical system 1 may be configured to provide an augmented reality interactive experience during a surgical procedure as described herein.

[0043] FIG. 2 depicts an example of a surgical system 2 to perform a surgical procedure on a patient lying down on an operating table 14 in a surgical operating room 16. A robotic system 10 is used in the surgical procedure as a part of the surgical system 2. The robotic system 10 includes a surgeon’s console 18, a patient side cart 20 (surgical robot), and a surgical robotic hub 22. The patient side cart 20 can manipulate at least one removably coupled surgical tool 17 through a minimally invasive incision in the body of the patient while the surgeon views the surgical site through the surgeon’s console 18 or an augmented reality (AR) device 66 worn by the surgeon. An image (e.g., still or live streamed in real time) of the surgical site during a minimally invasive procedure can be obtained by a medical imaging device 24. The patient side cart 20 can manipulate the imaging device 24 to orient the imaging device 24. An image of an open surgical procedure can be obtained by a medical imaging device 96. The robotic hub 22 processes the images of the surgical site for subsequent display on the surgeon’s console 18 or the AR device 66 worn by the surgeon, or other person in the surgical operating room 16.

[0044] The optical components of the imaging device 24, 96 or AR device 66 may include one or more illumination sources and/or one or more lenses. The one or more illumination sources may be directed to illuminate portions of the surgical field. One or more image sensors may receive light reflected or refracted from tissue and instruments in the surgical field.

[0045] In various aspects, the imaging device 24 is configured for use in a minimally invasive surgical procedure. Examples of imaging devices suitable for use with this disclosure include, but not limited to, an arthroscope, angioscope, bronchoscope, choledochoscope, colonoscope, cytoscope, duodenoscope, enteroscope, esophagogastro-duodenoscope (gastroscope), endoscope, laryngoscope, nasopharyngo-neproscope, sigmoidoscope, thoracoscope, and ureteroscope. In various aspects, the imaging device 96 is configured for use in an open (invasive) surgical procedure.

[0046] In various aspects, the visualization system 8 includes one or more imaging sensors, one or more image-processing units, one or more storage arrays, and one or more displays that are strategically arranged with respect to the sterile field. In one aspect, the visualization system 8 includes an interface for HL7, PACS, and EMR. In one aspect, the imaging device 24 may employ multi-spectrum monitoring to discriminate topography and underlying structures. A multi- spectral image captures image data within specific wavelength ranges in the electromagnetic spectrum. Wavelengths are separated by filters or instruments sensitive to particular wavelengths, including light from frequencies beyond the visible light range, e.g., IR and ultraviolet. Spectral imaging can extract information not visible to the human eye. Multi-spectrum monitoring can relocate a surgical field after a surgical task is completed to perform tests on the treated tissue.

[0047] FIG. 2 depicts a primary display 19 positioned in the sterile field to be visible to an operator at the operating table 14. A visualization tower 11 is positioned outside the sterile field and includes a first non-sterile display 7 and a second non-sterile display 9, which face away from each other. The visualization system 8, guided by the hub 6, is configured to utilize the displays 7, 9, 19 to coordinate information flow to operators inside and outside the sterile field. For example, the hub 6 may cause the visualization system 8 to display AR images of the surgical site, as recorded by an imaging device 24, 96 on a non-sterile display 7, 9, or through the AR device 66, while maintaining a live feed of the surgical site on the primary display 19 or the AR device 66. The non-sterile display 7, 9 can permit a non-sterile operator to perform a diagnostic step relevant to the surgical procedure, for example.

[0048] FIG. 3 depicts a hub 6 in communication with a visualization system 8, a robotic system 10, and a handheld intelligent surgical instrument 12. The hub 6 includes a hub display 35, an imaging module 38, a generator module 40, a communication module 30, a processor module 32, a storage array 34, and an operating room mapping module 33. The hub 6 further includes a smoke evacuation module 26 and/or a suction/irrigation module 28. In various aspects, the imaging module 38 comprises an AR device 66 and the processor module 32 comprises an integrated video processor and an augmented reality modeler (e.g., as shown in FIG. 10). A modular light source may be adapted for use with various imaging devices. In various examples, multiple imaging devices may be placed at different positions in the surgical field to provide multiple views (e.g., non-invasive, minimally invasive, invasive or open surgical procedures). The imaging module 38 can be configured to switch between the imaging devices to provide an optimal view. In various aspects, the imaging module 38 can be configured to integrate the images from the different imaging devices and provide an augmented reality interactive experience during a surgical procedure as described herein.

[0049] FIG. 4 shows a surgical data network 51 comprising a modular communication hub 53 configured to connect modular devices located in one or more operating theaters/rooms of a healthcare facility to a cloud-based system. The cloud 54 may include a remote server 63 (FIG. 5) coupled to a storage device 55. The modular communication hub 53 comprises a network hub 57 and/or a network switch 59 in communication with a network router 61 . The modular communication hub 53 is coupled to a local computer system 60 to process data. Modular devices 1a-1 n in the operating theater may be coupled to the modular communication hub 53. The network hub 57 and/or the network switch 59 may be coupled to a network router 61 to connect the devices 1a-1 n to the cloud 54 or the local computer system 60. Data associated with the devices 1a-1 n may be transferred to cloud-based computers via the router for remote data processing and manipulation. The operating theater devices 1a-1n may be connected to the modular communication hub 53 over a wired channel or a wireless channel. The surgical data network 51 environment may be employed to provide an augmented reality interactive experience during a surgical procedure as described herein and in particular providing augmented images if the surgical field to one or more than one remote display 58.

[0050] FIG. 5 illustrates a computer-implemented interactive surgical system 50. The computer-implemented interactive surgical system 50 is similar in many respects to the computer-implemented interactive surgical system 1 . The computer-implemented interactive surgical system 50 includes one or more surgical systems 52, which are similar in many respects to the surgical systems 2. Each surgical system 52 includes at least one surgical hub 56 in communication with a cloud 54 that may include a remote server 63. In one aspect, the computer-implemented interactive surgical system 50 comprises a modular control tower 23 connected to multiple operating theater devices such as, for example, intelligent surgical instruments, robots, and other computerized devices located in the operating theater. As shown in FIG. 6, the modular control tower 23 comprises a modular communication hub 53 coupled to a computer system 60.

[0051] Back to FIG. 5, the modular control tower 23 is coupled to an imaging module 38 that is coupled to an endoscope 98, a generator module 27 that is coupled to an energy device 99, a smoke evacuator module 76, a suction/irrigation module 78, a communication module 13, a processor module 15, a storage array 16, a smart device/instrument 21 optionally coupled to a display 39, and a sensor module 29. The operating theater devices are coupled to cloud computing resources such as server 63, data storage 55, and displays 58 via the modular control tower 23. A robot hub 72 also may be connected to the modular control tower 23 and to the servers 63, data storage 55, and displays 58. The devices/instruments 21 , visualization systems 58, among others, may be coupled to the modular control tower 23 via wired or wireless communication standards or protocols, as described herein. The modular control tower 23 may be coupled to a hub display 65 (e.g., monitor, screen) to display augmented images received comprising overlaid virtual objects on the real surgical field received from the imaging module 38, device/instrument display 39, and/or other visualization systems 58. The hub display 65 also may display data received from devices connected to the modular control tower 23 in conjunction with images and overlaid images.

[0052] FIG. 6 illustrates a surgical hub 56 comprising a plurality of modules coupled to the modular control tower 23. The modular control tower 23 comprises a modular communication hub 53, e.g., a network connectivity device, and a computer system 60 to provide local processing, visualization, and imaging of augmented surgical information, for example. The modular communication hub 53 may be connected in a tiered configuration to expand the number of modules (e.g., devices) that may be connected to the modular communication hub 53 and transfer data associated with the modules to the computer system 60, cloud computing resources, or both. Each of the network hubs/switches 57, 59 in the modular communication hub 53 may include three downstream ports and one upstream port. The upstream network hub/switch 57, 59 is connected to a processor 31 to provide a communication connection to the cloud computing resources and a local display 67. Communication to the cloud 54 may be made either through a wired or a wireless communication channel.

[0053] The computer system 60 comprises a processor 31 and a network interface 37. The processor 31 is coupled to a communication module 41 , storage 45, memory 46, non-volatile memory 47, and input/output interface 48 via a system bus. The system bus can be any of several types of bus structure(s) including the memory bus or memory controller, a peripheral bus or external bus, and/or a local bus using any variety of available bus architectures.

[0054] The processor 31 comprises an augmented reality modeler (e.g., as shown in FIG. 10) and may be implemented as a single-core or multicore processor such as those known under the trade name ARM Cortex by Texas Instruments. In one aspect, the processor may be an LM4F230H5QR ARM Cortex-M4F Processor Core, available from Texas Instruments, for example, comprising an on-chip memory of 256 KB single-cycle flash memory, or other non volatile memory, up to 40 MHz, a prefetch buffer to improve performance above 40 MHz, a 32 KB single-cycle serial random access memory (SRAM), an internal read-only memory (ROM) loaded with StellarisWare® software, a 2 KB electrically erasable programmable read-only memory (EEPROM), and/or one or more pulse width modulation (PWM) modules, one or more quadrature encoder inputs (QEI) analogs, one or more 12-bit analog-to-digital converters (ADCs) with 12 analog input channels, details of which are available for the product datasheet. [0055] The system memory includes volatile memory and non-volatile memory. The basic input/output system (BIOS), containing the basic routines to transfer information between elements within the computer system, such as during start-up, is stored in non-volatile memory. For example, the non-volatile memory can include ROM, programmable ROM (PROM), electrically programmable ROM (EPROM), EEPROM, or flash memory. Volatile memory includes random-access memory (RAM), which acts as external cache memory. Moreover,

RAM is available in many forms such as SRAM, dynamic RAM (DRAM), synchronous DRAM (SDRAM), double data rate SDRAM (DDR SDRAM), enhanced SDRAM (ESDRAM), Synchlink DRAM (SLDRAM), and direct Rambus RAM (DRRAM).

[0056] The computer system 60 also includes removable/non-removable, volatile/non volatile computer storage media, such as for example disk storage. The disk storage includes, but is not limited to, devices like a magnetic disk drive, floppy disk drive, tape drive, Jaz drive, Zip drive, LS-60 drive, flash memory card, or memory stick. In addition, the disk storage can include storage media separately or in combination with other storage media including, but not limited to, an optical disc drive such as a compact disc ROM device (CD-ROM), compact disc recordable drive (CD-R Drive), compact disc rewritable drive (CD-RW Drive), or a digital versatile disc ROM drive (DVD-ROM). To facilitate the connection of the disk storage devices to the system bus, a removable or non-removable interface may be employed.

[0057] In various aspects, the computer system 60 of FIG. 6, the imaging module 38 and/or visualization system 58, and/or the processor module 15 of FIGS. 4-6, may comprise an image processor, image-processing engine, graphics processing unit (GPU), media processor, or any specialized digital signal processor (DSP) used for the processing of digital images. The image processor may employ parallel computing with single instruction, multiple data (SIMD) or multiple instruction, multiple data (MIMD) technologies to increase speed and efficiency. The digital image-processing engine can perform a range of tasks. The image processor may be a system on a chip with multicore processor architecture. [0058] FIG. 7 illustrates an augmented reality system 263 comprising an intermediate signal combiner 64 positioned in the communication path between an imaging module 38 and a surgical hub display 67. The signal combiner 64 combines audio and/or image data received from an imaging module 38 and/or an AR device 66. The surgical hub 56 receives the combined data from the combiner 64 and overlays the data provided to the display 67, where the overlaid data is displayed. The imaging device 68 may be a digital video camera and the audio device 69 may be a microphone. The signal combiner 64 may comprise a wireless heads-up display adapter to couple to the AR device 66 placed into the communication path of the display 67 to a console allowing the surgical hub 56 to overlay data on the display 67.

[0059] FIG. 8 illustrates an augmented reality (AR) system comprising an intermediate signal combiner positioned in the communication path between an imaging module and a surgical hub display. FIG. 8 illustrates an AR device 66 worn by a surgeon 73 to communicate data to the surgical hub 56. Peripheral information of the AR device 66 does not include active video. Rather, the peripheral information includes only device settings, or signals that do not have same demands of refresh rates. Interaction may augment the surgeon's 73 information based on linkage with preoperative computerized tomography (CT) or other data linked in the surgical hub 56. The AR device 66 can identify structure - ask whether instrument is touching a nerve, vessel, or adhesion, for example. The AR device 66 may include pre-operative scan data, an optical view, tissue interrogation properties acquired throughout procedure, and/or processing in the surgical hub 56 used to provide an answer. The surgeon 73 can dictate notes to the AR device 66 to be saved with patient data in the hub storage 45 for later use in report or in follow up.

[0060] The AR device 66 worn by the surgeon 73 links to the surgical hub 56 with audio and visual information to avoid the need for overlays, and allows customization of displayed information around periphery of view. The AR device 66 provides signals from devices (e.g., instruments), answers queries about device settings, or positional information linked with video to identify quadrant or position. The AR device 66 has audio control and audio feedback from the AR device 66. The AR device 66 is able to interact with other systems in the operating theater and have feedback and interaction available wherever the surgeon 73 is viewing. For example, the AR device 66 may receive voice or gesture initiated commands and queries from a surgeon, and the AR device 66 may provide feedback in the form of one or more modalities including audio, visual, or haptic touch.

[0061] FIG. 9 illustrates a surgeon 73 wearing an AR device 66, a patient 74, and may include a camera 96 in an operating room 75. The AR device 66 worn by the surgeon 73 may be used to present to the surgeon 73 a virtual object overlaid on a real time image of the surgical field through augmented reality display 89 or through the hub connected display 67.

The real time image may include a portion of a surgical instrument 77. The virtual object may not be visible to others within the operating room 75 (e.g., surgical assistant or nurse), though they also may wear AR devices 66. Even if another person is viewing the operating room 75 with an AR device 66, the person may not be able to see the virtual object or may be able to see the virtual object in a shared augmented reality with the surgeon 73, or may be able to see a modified version of the virtual object (e.g., according to customizations unique to the surgeon 73) or may see different virtual objects.

[0062] A virtual object and/or data may be configured to appear on a portion of a surgical instrument 77 or in a surgical field of view captured by an imaging module 38, an imaging device 68 during minimally invasive surgical procedures, and/or the camera 96 during open surgical procedures. In the illustrated example, the imaging module 38 is a laparoscopic camera that provides a live feed of a surgical area during a minimally invasive surgical procedure. An AR system may present virtual objects that are fixed to a real object without regard to a perspective of a viewer or viewers of the AR system (e.g., the surgeon 73). For example, a virtual object may be visible to a viewer of the AR system inside the operating room 75 and not visible to a viewer of the AR system outside the operating room 75. The virtual object may be displayed to the viewer outside the operating room 75 when the viewer enters the operating room 75. The augmented image may be displayed on the surgical hub display 67 or the augmented reality display 89.

[0063] The AR device 66 may include one or more screens or lens, such as a single screen or two screens (e.g., one per eye of a user). The screens may allow light to pass through the screens such that aspects of the real environment are visible while displaying the virtual object. The virtual object may be made visible to the surgeon 73 by projecting light. A virtual object may appear to have a degree of transparency or may be opaque (i.e. , blocking aspects of the real environment).

[0064] An AR system may be viewable to one or more viewers, and may include differences among views available for the one or more viewers while retaining some aspects as universal among the views. For example, a heads-up display may change between two views while virtual objects and/or data may be fixed to a real object or area in both views. Aspects such as a color of an object, lighting, or other changes may be made among the views without changing a fixed position of at least one virtual object.

[0065] A user may see a virtual object and/or data presented in an AR system as opaque or as including some level of transparency. In an example, the user may interact with the virtual object, such as by moving the virtual object from a first position to a second position. For example, the user may move an object with his or her hand. This may be done in the AR system virtually by determining that the hand has moved into a position coincident or adjacent to the object (e.g., using one or more cameras, which may be mounted on the AR device 66, such as AR device camera 79 or separate 96, and which may be static or may be controlled to move), and causing the object to move in response. Virtual aspects may include virtual representations of real world objects or may include visual effects, such as lighting effects, etc. The AR system may include rules to govern the behavior of virtual objects, such as subjecting a virtual object to gravity or friction, or may include other predefined rules that defy real world physical constraints (e.g., floating objects, perpetual motion, etc.). The AR device 66 may include a camera 79 on the AR device 66 (not to be confused with the camera 96, separate from the AR device 66). The AR device camera 79 or the camera 96 may include an infrared camera, an infrared filter, a visible light filter, a plurality of cameras, a depth camera, etc. The AR device 66 may project virtual items over a representation of a real environment, which may be viewed by a user.

[0066] The AR device 66 may be used in the operating room 75 during a surgical procedure, for example performed by the surgeon 73 on the patient 74. The AR device 66 may project or display virtual objects, such as a virtual object during the surgical procedure to augment the surgeon's vision. The surgeon 73 may view a virtual object using the AR device 66, a remote controller for the AR device 66, or may interact with a virtual object, for example, using a hand to “interact” with a virtual object or a gesture recognized by the camera 79 of the AR device 66. A virtual object may augment a surgical tool such as the surgical instrument 77. For example, the virtual object may appear (to the surgeon 73 viewing the virtual object through the AR device 66) to be coupled with or remain a fixed distance from the surgical instrument 77. In another example, the virtual object may be used to guide the surgical instrument 77, and may appear to be fixed to the patient 74. In certain examples, a virtual object may react to movements of other virtual or real-world objects in the surgical field. For example, the virtual object may be altered when a surgeon is manipulating a surgical instrument in proximity to the virtual object.

[0067] The augmented reality display system imaging device 38 capture a real image of a surgical area during a surgical procedure. An augmented reality display 89, 67 presents an overlay of an operational aspect of the surgical instrument 77 onto the real image of the surgical area. The surgical instrument 77 includes communications circuitry 231 to communicate operational aspects and functional data from the surgical instrument 77 to the AR device 66 via communication communications circuitry 233 on the AR device 66. Although the surgical instrument 77 and the AR device 66 are shown in RF wireless communication between circuits 231 , 233 as indicated by arrows B, C, other communication techniques may employed (e.g., wired, ultrasonic, infrared, etc.). The overlay is related to the operational aspect of the surgical instrument 77 being actively visualized. The overlay combines aspects of tissue interaction in the surgical area with functional data from the surgical instrument 77. A processor portion of the AR device 66 is configured to receive the operational aspects and functional data from the surgical instrument 77, determine the overlay related to the operation of the surgical instrument 77, and combine the aspect of the tissue in the surgical area with the functional data from the surgical instrument 77. The augmented images indicate alerts relative to device performance considerations, alerts of incompatible usage, alerts on incomplete capture. Incompatible usage includes tissue out range conditions and tissue incorrectly balanced within the jaws of the end effector. Additional augmented images provide an indication of collateral events including indication of tissue tension and indication of foreign object detection. Other augmented images indicate device status overlays and instrument indication.

[0068] FIG. 10 illustrates a system 83 for augmenting images of a surgical field with information using an AR display 89, in accordance with at least one aspect of this disclosure. The system 83 may be used to perform the techniques described hereinbelow, for example, by using the processor 85. The system 83 includes one aspect of an AR device 66 that may be in communication with a database 93. The AR device 66 includes a processor 85, memory 87, an AR display 89, and a camera 79. The AR device 66 may include a sensor 90, a speaker 91 , and/or a haptic controller 92. The database 93 may include image storage 94 or preoperative plan storage 95.

[0069] The processor 85 of the AR device 66 includes an augmented reality modeler 86.

The augmented reality modeler 86 may be used by the processor 85 to create the augmented reality environment. For example, the augmented reality modeler 86 may receive images of the instrument in a surgical field, such as from the camera 79 or sensor 90, and create the augmented reality environment to fit within a display image of the surgical field of view. In another example, physical objects and/or date may be overlaid on the surgical field of view and/or the surgical instruments images and the augmented reality modeler 86 may use physical objects and data to present the augmented reality display of virtual object s and/or data in the augmented reality environment. For example, the augmented reality modeler 86 may use or detect an instrument at a surgical site of the patient and present a virtual object and/or data on the surgical instrument and/or an image of the surgical site in the surgical field of view captured by the camera 79. The AR display 89 may display the AR environment overlaid on a real environment. The display 89 may show a virtual object and/or data, using the AR device 66, such as in a fixed position in the AR environment.

[0070] The AR device 66 may include a sensor 90, such as an infrared sensor. The camera 79 or the sensor 90 may be used to detect movement, such as a gesture by a surgeon or other user, that may be interpreted by the processor 85 as attempted or intended interaction by the user with the virtual target. The processor 85 may identify an object in a real environment, such as through processing information received using the camera 79. In other aspects, the sensor 90 may be a tactile, audible, chemical, or thermal sensor to generate corresponding signals that may combined with various data feeds to create the augmented environment. The sensor 90 may include binaural audio sensors (spatial sound), inertial measurement (accelerometer, gyroscope, magnetometer) sensors, environmental sensors, depth camera sensors, hand and eye tracking sensors, and voice command recognition functions.

[0071] The AR display 89, for example during a surgical procedure, may present, such as within a surgical field while permitting the surgical field to be viewed through the AR display 89, a virtual feature corresponding to a physical feature hidden by an anatomical aspect of a patient. The virtual feature may have a virtual position or orientation corresponding to a first physical position or orientation of the physical feature. In an example, the virtual position or orientation of the virtual feature may include an offset from the first physical position or orientation of the physical feature. The offset may include a predetermined distance from the augmented reality display, a relative distance from the augmented reality display to the anatomical aspect, or the like.

[0072] In one example, the AR device 66 may be an individual AR device. In one aspect, the AR device 66 may be a HoloLens 2 AR device manufactured by Microsoft of Redmond, Wash. This AR device 66 includes a visor with lenses and binaural audio features (spatial sound), inertial measurement (accelerometer, gyroscope, magnetometer), environmental sensors, depth camera, and video camera, hand and eye tracking, and voice command recognition functions. It provides an improved field of view with high resolution by using mirrors to direct waveguides in front of wearer's eyes. Images can be enlarged by changing angles of mirrors. It also provides eye tracking to recognize users and adjust lens widths for specific users.

[0073] In another example, the AR device 66 may be a Snapchat Spectacles 3 AR device. This AR device provides the ability to capture paired images and recreate 3D depth mapping, add in virtual effects, and replay 3D videos. The AR device includes two HD cameras to capture 3D photos and videos at 60 fps — while four built-in microphones record immersive, high-fidelity audio. Images from both cameras combine to build out a geometric map of the real world around the user to provide a new sense of depth perception. Photos and videos may be wirelessly synchronized to external display devices.

[0074] In yet another example, the AR device 66 may be a Glass 2 AR device by Google. This AR device provides inertial measurement (accelerometer, gyroscope, magnetometer) information overlaid on lens (out of view) to supplement information.

[0075] In another example, the AR device 66 may be an Echo Frames AR device by Amazon. This AR device does not have cameras/displays. A microphone and speaker are linked to Alexa. This AR device provides less functionality than a heads-up display.

[0076] In yet another example, the AR device 66 may be a Focals AR device by North (Google). This AR device provides notification pusher/smartwatch analog; inertial measurement, screen overlay of information (weather, calendar, messages), voice control (Alexa) integration. This AR device provides basic heads-up display functionality.

[0077] In another example, the AR device 66 may be an Nreal AR device. This AR device includes spatial sound, two environmental cameras, a photo camera, IMU (accelerometer, gyroscope), ambient light sensor, proximity sensor functionality. A nebula projects application information on lenses.

[0078] In various other examples, the AR device 66 may be any one of the following commercially available AR devices: Magic Leap 1 , Epson Moverio, Vuzix Blade AR, ZenFone AR, Microsoft AR glasses prototype, EyeT ap to create collinear light to that of the environment directly into the retina. A beam splitter makes the same light seen by the eye available to the computer to process and overlay information, for example. AR visualization systems include HUD, contact lenses , glasses, virtual reality (VR) headsets, virtual retinal display, on in operating room displays, and/or smart contact lenses (bionic lenses).

[0079] Multi-user interfaces for the AR device 66 include virtual retinal displays such as raster displays drawn directly on retinas instead of on a screen in front of the eye, smart televisions, smart phones, and / or spatial displays such as Sony spatial display systems.

[0080] Other AR technology may include, for example, AR capture devices and software applications, AR creation devices and software applications, and AR cloud devices and software applications. AR capture devices and software applications include, for example, Apple Polycam app, Ubiquity 6 (Mirrorworld using Display. land app) - users can scan and get 3d image of real world (to create 3D model). AR creation devices and software applications include, for example, Adobe Aero, Vuforia, ARToolKit, Google ARCore, Apple ARKit, MAXST, Aurasma, Zappar, Blippar. AR cloud devices and software applications include, for example, Facebook, Google (world geometry, objection recognition, predictive data), Amazon AR Cloud (commerce), Microsoft Azure, Samsung Project Whare, Niantic, Magic Leap.

[0081] Situational awareness is the ability of some aspects of a surgical system to determine or infer information related to a surgical procedure from data received from databases and/or instruments. The information can include the type of procedure being undertaken, the type of tissue being operated on, or the body cavity that is the subject of the procedure. With the contextual information related to the surgical procedure, the surgical system can, for example, improve the manner in which it controls the modular devices (e.g., a robotic arm and/or robotic surgical tool) that are connected to it and provide contextualized information or suggestions to the surgeon during the course of the surgical procedure.

[0082] FIG. 11 illustrates a timeline of a situational awareness surgical procedure. FIG. 11 illustrates a timeline 5200 of an illustrative surgical procedure and the contextual information that a surgical hub 5104 can derive from the data received from the data sources 5126 at each step in the surgical procedure. The timeline 5200 depicts the typical steps that would be taken by the nurses, surgeons, and other medical personnel during the course of a lung segmentectomy procedure, beginning with setting up the operating theater and ending with transferring the patient to a post-operative recovery room. The situationally aware surgical hub 5104 receives data from the data sources 5126 throughout the course of the surgical procedure, including data generated each time medical personnel utilize a modular device 5102 that is paired with the surgical hub 5104. The surgical hub 5104 can receive this data from the paired modular devices 5102 and other data sources 5126 and continually derive inferences (i.e., contextual information) about the ongoing procedure as new data is received, such as which step of the procedure is being performed at any given time. The situational awareness system of the surgical hub 5104 is able to, for example, record data pertaining to the procedure for generating reports, verify the steps being taken by the medical personnel, provide data or prompts (e.g., via a display screen) that may be pertinent for the particular procedural step, adjust modular devices 5102 based on the context (e.g., activate monitors, adjust the FOV of the medical imaging device, or change the energy level of an ultrasonic surgical instrument or RF electrosurgical instrument), and take any other such action described above.

[0083] First 5202, the hospital staff members retrieve the patient’s EMR from the hospital’s EMR database. Based on select patient data in the EMR, the surgical hub 5104 determines that the procedure to be performed is a thoracic procedure.

[0084] Second 5204, the staff members scan the incoming medical supplies for the procedure. The surgical hub 5104 cross-references the scanned supplies with a list of supplies that are utilized in various types of procedures and confirms that the mix of supplies corresponds to a thoracic procedure. Further, the surgical hub 5104 is also able to determine that the procedure is not a wedge procedure (because the incoming supplies either lack certain supplies that are necessary for a thoracic wedge procedure or do not otherwise correspond to a thoracic wedge procedure).

[0085] Third 5206, the medical personnel scan the patient band via a scanner 5128 that is communicably connected to the surgical hub 5104. The surgical hub 5104 can then confirm the patient’s identity based on the scanned data.

[0086] Fourth 5208, the medical staff turns on the auxiliary equipment. The auxiliary equipment being utilized can vary according to the type of surgical procedure and the techniques to be used by the surgeon, but in this illustrative case they include a smoke evacuator, insufflator, and medical imaging device. When activated, the auxiliary equipment that are modular devices 5102 can automatically pair with the surgical hub 5104 that is located within a particular vicinity of the modular devices 5102 as part of their initialization process. The surgical hub 5104 can then derive contextual information about the surgical procedure by detecting the types of modular devices 5102 that pair with it during this pre-operative or initialization phase. In this particular example, the surgical hub 5104 determines that the surgical procedure is a VATS procedure based on this particular combination of paired modular devices 5102. Based on the combination of the data from the patient’s EMR, the list of medical supplies to be used in the procedure, and the type of modular devices 5102 that connect to the hub, the surgical hub 5104 can generally infer the specific procedure that the surgical team will be performing. Once the surgical hub 5104 knows what specific procedure is being performed, the surgical hub 5104 can then retrieve the steps of that procedure from a memory or from the cloud and then cross-reference the data it subsequently receives from the connected data sources 5126 (e.g., modular devices 5102 and patient monitoring devices 5124) to infer what step of the surgical procedure the surgical team is performing.

[0087] Fifth 5210, the staff members attach the EKG electrodes and other patient monitoring devices 5124 to the patient. The EKG electrodes and other patient monitoring devices 5124 are able to pair with the surgical hub 5104. As the surgical hub 5104 begins receiving data from the patient monitoring devices 5124, the surgical hub 5104 thus confirms that the patient is in the operating theater.

[0088] Sixth 5212, the medical personnel induce anesthesia in the patient. The surgical hub 5104 can infer that the patient is under anesthesia based on data from the modular devices 5102 and/or patient monitoring devices 5124, including EKG data, blood pressure data, ventilator data, or combinations. Upon completion of the sixth step 5212, the pre-operative portion of the lung segmentectomy procedure is completed and the operative portion begins. [0089] Seventh 5214, the patient’s lung that is being operated on is collapsed (while ventilation is switched to the contralateral lung). The surgical hub 5104 can infer from the ventilator data that the patient’s lung has been collapsed. The surgical hub 5104 can infer that the operative portion of the procedure has commenced as it can compare the detection of the patient’s lung collapsing to the expected steps of the procedure (which can be accessed or retrieved previously) and thereby determine that collapsing the lung is the first operative step in this particular procedure.

[0090] Eighth 5216, the medical imaging device 5108 (e.g., a scope) is inserted and video from the medical imaging device is initiated. The surgical hub 5104 receives the medical imaging device data (i.e., still image data or live streamed video in real time) through its connection to the medical imaging device. Upon receipt of the medical imaging device data, the surgical hub 5104 can determine that the laparoscopic portion of the surgical procedure has commenced. Further, the surgical hub 5104 can determine that the particular procedure being performed is a segmentectomy, as opposed to a lobectomy (note that a wedge procedure has already been discounted by the surgical hub 5104 based on data received at the second step 5204 of the procedure). The data from the medical imaging device 124 (FIG. 2) can be utilized to determine contextual information regarding the type of procedure being performed in a number of different ways, including by determining the angle at which the medical imaging device is oriented with respect to the visualization of the patient’s anatomy, monitoring the number or medical imaging devices being utilized (i.e., that are activated and paired with the surgical hub 5104), and monitoring the types of visualization devices utilized.

[0091] For example, one technique for performing a VATS lobectomy places the camera in the lower anterior corner of the patient’s chest cavity above the diaphragm, whereas one technique for performing a VATS segmentectomy places the camera in an anterior intercostal position relative to the segmental fissure. Using pattern recognition or machine learning techniques, for example, the situational awareness system can be trained to recognize the positioning of the medical imaging device according to the visualization of the patient’s anatomy. As another example, one technique for performing a VATS lobectomy utilizes a single medical imaging device, whereas another technique for performing a VATS segmentectomy utilizes multiple cameras. As yet another example, one technique for performing a VATS segmentectomy utilizes an infrared light source (which can be communicably coupled to the surgical hub as part of the visualization system) to visualize the segmental fissure, which is not utilized in a VATS lobectomy. By tracking any or all of this data from the medical imaging device 5108, the surgical hub 5104 can thereby determine the specific type of surgical procedure being performed and/or the technique being used for a particular type of surgical procedure.

[0092] Ninth 5218, the surgical team begins the dissection step of the procedure. The surgical hub 5104 can infer that the surgeon is in the process of dissecting to mobilize the patient’s lung because it receives data from the RF or ultrasonic generator indicating that an energy instrument is being fired. The surgical hub 5104 can cross-reference the received data with the retrieved steps of the surgical procedure to determine that an energy instrument being fired at this point in the process (i.e. , after the completion of the previously discussed steps of the procedure) corresponds to the dissection step.

[0093] Tenth 5220, the surgical team proceeds to the ligation step of the procedure. The surgical hub 5104 can infer that the surgeon is ligating arteries and veins because it receives data from the surgical stapling and cutting instrument indicating that the instrument is being fired. Similarly to the prior step, the surgical hub 5104 can derive this inference by cross- referencing the receipt of data from the surgical stapling and cutting instrument with the retrieved steps in the process.

[0094] Eleventh 5222, the segmentectomy portion of the procedure is performed. The surgical hub 5104 infers that the surgeon is transecting the parenchyma based on data from the surgical instrument, including data from a staple cartridge. The cartridge data may correspond to size or type of staple being fired by the instrument. The cartridge data can indicate the type of tissue being stapled and/or transected for different types of staples utilized in different types of tissues. The type of staple being fired is utilized for parenchyma or other tissue types to allow the surgical hub 5104 to infer that the segmentectomy procedure is being performed.

[0095] Twelfth 5224, the node dissection step is then performed. The surgical hub 5104 can infer that the surgical team is dissecting the node and performing a leak test based on data received from the generator indicating that an RF or ultrasonic instrument is being fired. For this particular procedure, an RF or ultrasonic instrument being utilized after parenchyma was transected corresponds to the node dissection step, which allows the surgical hub 5104 to make this inference. It should be noted that surgeons regularly switch back and forth between surgical stapling/cutting instruments and surgical energy (i.e., RF or ultrasonic) instruments depending upon the particular step in the procedure because different instruments are better adapted for particular tasks. Therefore, the particular sequence in which the stapling/cutting instruments and surgical energy instruments are used can indicate what step of the procedure the surgeon is performing. Upon completion of the twelfth step 5224, the incisions and closed up and the post operative portion of the procedure begins.

[0096] Thirteenth 5226, the patient’s anesthesia is reversed. The surgical hub 5104 can infer that the patient is emerging from the anesthesia based on the ventilator data (i.e. , the patient’s breathing rate begins increasing), for example.

[0097] Lastly, fourteenth 5228, the medical personnel remove the various patient monitoring devices 5124 from the patient. The surgical hub 5104 can thus infer that the patient is being transferred to a recovery room when the hub loses EKG, BP, and other data from the patient monitoring devices 5124. The surgical hub 5104 can determine or infer when each step of a given surgical procedure is taking place according to data received from the various data sources 5126 that are communicably coupled to the surgical hub 5104.

[0098] In addition to utilizing the patient data from EMR database(s) to infer the type of surgical procedure that is to be performed, as illustrated in the first step 5202 of the timeline 5200 depicted in FIG. 11 , the patient data can also be utilized by a situationally aware surgical hub 5104 to generate control adjustments for the paired modular devices 5102.

[0099] The present disclosure provides a system, method, and device for displaying relevant augmented reality (AR) content to the surgical staff members without over-saturating the augmented display with virtual elements. The surgical staff members (e.g. doctors, nurses, surgeons, technicians, etc.) require AR content that is delicately balanced between displaying helpful information without distracting the surgeon. A surgical hub receives a plurality of inputs related to surgical environment and displays only necessary information to allow the surgeon to provide effective care to the patient.

[0100] In various aspects, the surgical hub generates virtual elements that are displayed in response to a triggered event or an evaluation of contextual parameter received by the situational awareness system (FIG. 11). The surgical hub may determine contextual information of the surgical procedure and environment including a current surgical procedure, an expected next step in the surgical procedure, and/or an active surgical instrument. The surgical hub evaluates the contextual information determine whether information is relevant, and provide necessary or emergency information to the surgeon. If the surgeon is inundated with information, they may begin to ignore notifications or have a difficult time distinguishing between monitored information and emergency notifications.

[0101] Additionally, the surgical hub may selectively display or update information at a refresh rate that is useful for the surgeon but not does create a lag, jitter, or delay. An essential component of AR content is that it is consumed by the user in real-time. Emergency notification must be immediately displayed and therefore processing lags and delays are unacceptable in a surgical environment. In order to prevent network and processing delays, certain traffic and virtual elements may be prioritized over others. In one aspect, certain parameters may be continuously monitored by the surgical hub, but only displayed in response to a predetermined threshold or a trigger event. The trigger event may include audible noise interference, low or high availability of bandwidth, and activation of a medical system, an unanticipated medical event, etc.

[0102] In various aspect, a trigger event may include an anticipated signal interruption that is the result of a surgical system, such as a mono-polar or bi-polar energy system. In response to the trigger event, the surgical hub may be configured to automatically display a warning on an AR device, or take remedial action and notify the surgical staff members through on an AR device.

[0103] In one aspect, the surgical hub may use redundant communication protocols for high resiliency communication. Redundant communication has a higher packet payload than a low weight packet like User Datagram Protocol (UDP), but comprises built-in redundancies to ensure packet receipt, such as checksum. The surgical hub may determine that a surgical device is connected to the surgical hub with an interference susceptible communication protocol, and suggests that the surgical device moves to a more resilient communication protocol, such as a low communication throughput Bluetooth. If the surgical device experiences interference during a communication transfer, the device can be rescanned after the procedure to initiate the transfer and confirm that the data received by the surgical hub was accurate. [0104] In various aspects, the surgical hub evaluates a plurality of surgical systems and signal present during the surgical procedure to determine and prevent signal interference. FIG. 12 shows a graphical representation 17100 of frequency shifting response by a surgical hub 6, 56 (FIGS. 1-3, 5-8) to anticipated signal interference. Prior to the generation of signal 17106 by a first surgical device, the surgical hub may notify the surgical staff that a second surgical device produces signal 17104 that may experience interference or signal interruption during the use of the first surgical device. The surgical hub may prompt the second surgical device to shift communication signals to a different frequency, outside the frequency spectrum of the first surgical device. Additionally, if the surgical hub deems that the communication by the second surgical device is a critical communication, the surgical hub may automatically shift the frequency of signal 17104 to the frequency at 17102. In one example, the 2.4 gHz frequency band is commonly used for under IEEE 802.11 for wireless communication, but is also used by electromechanical equipment. A bio-polar or monopolar energy system by generate signal noise in the 2.4 gHz frequency band that results in high packet loss and thus, communication delay. In order to avoid signal interference and communication delay, the surgical hub by seek another frequency band such as the 5.0 gHz frequency band. The second surgical device may then be enable to dynamically channel hop or channel hop based on a trigger communication sent by the surgical hub. Prior to the beginning of the surgical procedure, the surgical hub may recognize a potential communication interference between two devices and may initiate the prompt at the outset of surgery or automatically enable channel hoping as a precaution.

[0105] The surgical hub receives contextual data that indicates the specific procedure that is to be performed, the surgical instruments that are used during the procedure, situations when the surgical instruments are surgical instruments must be activated, flexible time intervals when the instruments may be activated, the potential for interference due to instrument activation, and the type of interference. Based on this information, the surgical hub can automatically schedule the activation of surgical systems and communication to avoid an anticipated interference.

[0106] FIG. 13 shows a timeline 17200 of device activation and communication transmissions scheduled by a surgical hub 6, 56 (FIGS. 1-3, 5-8). The surgical hub may delay communication signals 17204a until after the activation of a surgical system at 17202a. The surgical hub repeats this sequence by delaying the communication of signals 17204b, until after the activation of the surgical system at 17202b. The surgical determines, based on a hierarchy of communication and device activation, that communication signal 17204 is a critical communication and all other devices are deactivated. Typically the surgical system 17202 would be activated, but is delayed for a critical communication. Upon the completion of the signal transmission 17204, the surgical system resumes activation at 17202c.

[0107] FIG. 14 shows a flow diagram 17300 to evaluate a plurality of factors and determine a hierarchy of communication and device activation. The surgical hub 6, 56 (FIGS. 1-3, 5-8) may determine 17302 a hierarchy based on the schedule of device activation in a surgical procedure and anticipated interference. The surgical hub also may prioritize certain communications, in real-time, based on critical factors (e.g., life and death situations). The surgical hub determines 17304 the type of interference that may inhibit the effectiveness of a device or system, and the degree for the interference to be perceptible. For example, the surgical hub 6, 56 determines 17304b if device is susceptible to the type of interference/noise that can be produced by the potential interference causing signal. The surgical hub 6, 56 uses tracking and position information to determine 17306 whether the first device is located or positioned within the body of the patient. For example, the surgical hub 6, 56 determines 17306a if the device is located inside the body of the patient. A surgical device may comprise proximity markers that allow a tracking system to determine the location of various ends of the device in relation to the patient and other devices. The proximity to the patient can indicate the active use, or imminent use of a device. The surgical hub 6, 56 may be configured to determine the proximal relationship between devices and system to evaluate the likelihood of interfering systems. The surgical hub 6, 56 determines 17308 the location or proximity of the first devices to the potential interference causing device. For example, the surgical hub 6, 56 determines 17308a if the device is located within a predetermined distance from potential interference causing device. Further, the surgical hub 6, 56 determines 17308b affected proximity based on interference/noise type generated by the potential interference causing device. The surgical hub 6, 56 can further evaluate a predetermine range that the inference can propagate. The surgical hub evaluates, based on the situation awareness system, the contextual parameters that indicate whether a communication or activation schedule is flexible. The surgical hub 6, 56 determines 17310 whether the first device is in active usage/currently performing function. For example, the surgical hub 6, 56 determines 17310a if the device is in active operation mode. Further, the surgical hub 6, 56 determines 17310b if change in location, position, user inputs, power level, indicate device is in active operation or will be in inactive operation.

[0108] Prior to the activation of a first surgical device, the first surgical device sends a communication to the surgical hub that a potential noise/interference inducing event is about to occur. In response to the communication, the surgical hub changes one or more settings to mitigate the anticipated interference. In one example, bi-polar and mono-polar ablation systems are used during the same surgical procedure. The activation of the mono-polar system will interfere with the impedance control of the bipolar system. If the bi-polar is already in-cycle and the mono-polar is activated, the surgical hub changes the bi-polar control loop to continue operating in the manner just prior to the activation, rather than prohibiting the combined use of both devices. When the interface stops, the bi-polar goes back to its normal closed loop use.

[0109] In another aspect, the surgical hub is configured to takes a snap shot of setting or present operations for all the surgical devices. The snap shot of settings is used as a precaution in case one or more of the surgical devices is required to re-setup and reconnect to the surgical hub. Additionally, the snapshot may be used to reestablish a network communication setup (e.g. SSID, network domain, wireless communication authorization) and potential sub-device settings (by retransmitting the data back to the devices).

[0110] FIG. 15 shows a graphical representation 17400 of an end effector signal and noise as the end effector clamps onto tissue and is in the process of firing. A mono-polar or microwave ablation system is activated and interferes with the internal function of the closed loop firing control of the end effector. Signal 17406 represents the interference signal. The microwave ablation system creates an RF overload or saturation event and can interfere with the control signal of the end effector. The mono-polar ablation system produces RF energy that could propagate noise up the metallic shaft into the contacts and cause a similar RF saturation event. Signal 17402 shows the desired result of the end effector and signal 17404 shows a failure in the control loop sensors and causes the end effector to stop. Once the interference event is finished, the surgical hub may repopulate the error term and rate cells of the PWM and enable the end effector to resume where it left off and finish the operation.

[0111] In various aspect, the surgical hub may determine that the repopulation of settings and error terms is prohibited. In one example, an ARM processor itself may be affected interference, not just the sub-function of a motor control, thus the surgical hub would prohibit repopulation. In another examples, the surgical hub determines that a predetermined amount of time has elapsed since the start of the interface, then the system could be reset rather than restarted. In other cases, the surgical hub may be required to initiate additional steps as part of the repopulation process. In the case of pulmonary artery or pulmonary vein transections, the system may require that the tissue is unclamped, checked, augmented, or reviewed prior to allows the end effector to complete the transection.

[0112] In various aspect, the surgical hub notifies sub-devices that could be affected directly by an anticipated interference event. The warning allows the sub-devices to prepare internal defenses for the anticipated interference. The internal defenses may include enabling noise filters that allow the device to continue to operate through periods of signal interference. The signal noise filters may be internal signal processing and built into the device.

[0113] In various aspect, the surgical hub comprises a noise receiver that monitors external noise and then communicates a warning to one or more surgical devices. External noise (e.g. audible, impedance, frequency, or other electrical signals) is sensed and generator/device signal (i.e. , volume output, frequency output) may be adjusted according to a specific interference to compensate.

[0114] In various aspect, the surgical hub prohibits the combined activation or utilization of systems that have been identified to conflict or potentially interfere with one another. The surgical hub generates a warning and then inhibits any devices that could malfunction while being used while the noise event is in effect, according to a hierarchy of interference (FIG. 14). Additionally hierarchy factors include the prioritization of communication based on critical life support procedures, devices, and to maintain patient hemostasis (FIG. 14). The surgical hub prioritizes cooperative interaction of systems, such that the scheduling of communication and device activation is imperceptible to the surgical staff. Accordingly, critical communications and critical life support procedures may always be prioritized.

[0115] FIG. 16 shows a flow diagram 17500 of surgical hub responses based on the anticipation or detection of a trigger event. The surgical hub notifies 17502 one or more devices of a detected or anticipated interference. The surgical hub takes a snapshot 17504 of all device settings, and determines whether the device(s) are may be reset and repopulated without issue. If the devices permit, the surgical hub initiates 17508 a repopulation event. Additionally or alternatively, the surgical hub determines 17510 the type of interference, and notifies 17512 a sub-device system of the anticipated interference type. The sub-device responds by initiating 17514 a defense to the interference (e.g. channel hopping). The surgical hub may evaluate and determine 17516 the communication and activation of systems according to a hierarchy of critical systems. The surgical hub determines 17518 whether the systems may interact in cooperation for concurrent operation or the systems need to be prioritized for sequential operation. In response to the interference type and schedule of systems, the surgical hub prevents 17520 the operation of one or more systems.

[0116] In various aspects, the surgical hub determines a trigger event based on a change in force or motion exerted on tissue during a retraction. In response the surgical hub generates a preemptive warning that displays tissue tension or similar metrics that provide real-time measurements of the retraction, as a virtual element, on an AV display. Additionally, the surgical hub may display measurements of displacement and force in relation to the patient or the ground. This information is useful for the surgeon to balance the intended forces of gravity, tissue tension, and grip force without creating undue collateral damage, or forces that were not intended for adjacent connections.

[0117] In various aspects, the surgical hub may continuously monitor a plurality of surgical parameters including force, direction, and magnitude created by a surgical instrument on tissue. Additionally, the surgical hub may determine that a force meets or exceeds a predetermined threshold at a specific location. In response, the surgical hub may initiate the display of a virtual element.

[0118] The surgical hub is configured to continuously monitor the force exerted on one or more organs as part of a surgical procedure, wherein the organs are retracted to aid the surgeon’s vision in a laparoscopic procedure. If an organ fails to remain retracted, the surgeon’s vision may be impeded or damage may result to the organ. The surgical hub may employ a predictive algorithm to evaluate changes in position, movement, and force of the organs. The predictive algorithm may identify a likely increase in tissue tension that exceeds a predetermined amount, at a specific location, and automatically displays a warning to the surgeon.

[0119] A warning may be provided in the form of an alert, notification, audio or visual cues, or message on a display. Tissue tension created by a surgical instrument may be display in real-time on an OR display. The system is configured to measure and monitor the force, tension and/or change in force or tension as related to the patient and/or the ground. The system may detection the initiation of force, the time that the force was initiated, and compare to an expected amount of tension or force. Real-time display is configured to provide warnings when tissue tension exceeds an intended level to prevent unintended tissue damage and undue collateral consequences.

[0120] With reference now to FIGS. 17 and 18, the disclosure turns to description of a method 17260 for managing surgical device 21 interaction during a surgical procedure. The method 17260 shown in FIG. 18 may be practiced by the system 17250 shown in FIG. 17. According to the method 17260, a surgical hub 56 determines 17262 contextual parameters from a surgical environment. As shown in FIG. 17, and in more detail in FIG. 6, the surgical hub 56 comprises a computer 60 including a control circuit 31 (e.g., a processor) coupled to a memory 45, among other components. The surgical hub 56 determines 17264 a specific surgical procedure being performed in an operating room based on the contextual parameters. The surgical hub 56 receives 17266 procedural data from a remote server 63. The procedural data indicates steps and surgical instruments 21 associated with the specific surgical procedure. The surgical hub 56 determines 17268 that a trigger event is anticipated based on the procedural data and the contextual parameters. The surgical hub 56 initiates 17270 a response according to the surgical instruments 21 and the procedural data.

[0121] In other aspects of the method 17260, the surgical hub 56 may further determine a current procedural step of the surgical procedure. The current procedural step activates a first surgical device 21 and the surgical hub 56 determines that the first surgical device 21 is anticipated to interfere a communication of a second surgical device 21. Accordingly, the surgical hub 56 notifies the second surgical device 21 of the anticipated interference and enables an interference defense on the second surgical device 21. In one aspect, the interference defense enabled by the surgical hub 56 is a frequency shifting protocol configured to shift from a communication signal outside of an anticipated interference frequency band.

[0122] In other aspects of the method 17260, the surgical hub 56 may further determine a current procedural step of the surgical procedure. The current procedural step activates a first surgical device 21. The surgical hub 56 determines that the first surgical device 21 is anticipated to interfere a communication of a second surgical device 21. The surgical hub 56 determines that the first surgical device 21 and the second surgical device 21 are operable in a cooperative schedule. The surgical hub 56 may then activate the first surgical device 21 and in response to completing a first surgical device activation, the surgical hub may initiate a communication of the second surgical device 21 .

[0123] In other aspects of the method 17260, the trigger event is associated with a change in force exhibited on tissue while the tissue is being retracted. The change in force is determined by the surgical hub 56 based on readings from the surgical device 21 and is based on exceeding a predetermine tissue tension. Further, according to the method 17260, the surgical hub 56 generates a virtual element to display on an augmented reality (AR) device 66. The virtual element provides monitoring information for the retracted tissue.

[0124] Various additional aspects of the subject matter described herein are set out in the following numbered examples:

[0125] Example 1 : A surgical system comprises: a remote server; augmented reality (AR) output device; one or more surgical devices; a surgical hub communicatively coupled to the remote server, the one or more surgical devices, and the AR output device, the surgical hub comprises a control circuit coupled to a memory, and wherein the control circuit is configured to: determine contextual parameters from a surgical environment; determine from the contextual parameter a specific surgical procedure being performed in an operating room; receive procedural data from the remote server, wherein the procedural data indicates steps and surgical instruments associated with the specific surgical procedure; determine that a trigger event is anticipated based on the procedural data and the contextual parameters; initiate a response to the anticipated trigger event according to the surgical instruments and procedural data.

[0126] Example 2: The system of Example 1 , wherein the control circuit is further configured to: determine a current procedural step of the surgical procedure, wherein the current procedural step activates a first surgical device; determine that that the first surgical device is anticipated to interfere in a communication of a second surgical device; notify the second surgical device of the anticipated interference; enable an interference defense on the second surgical device.

[0127] Example 3: The system of Example 2, wherein the interference defense is a frequency shifting protocol configured to shift from a communication signal outside of an anticipated interference frequency band.

[0128] Example 4: The system of any one of Examples 1-3, wherein the control circuit is further configured to: determine a current procedural step of the surgical procedure, wherein the current procedural step activates a first surgical device; determine that that the first surgical device is anticipated to interfere the communication of a second surgical device; determine that the first surgical device and the second surgical device are operable in a cooperative schedule. [0129] Example 5: The system of Example 4, wherein the control circuit is further configured to: active the first surgical device; and in response to a completed first surgical device activation, initiate the communication of the second surgical device.

[0130] Example 6: The system of anyone of Examples 1-5, wherein the control circuit is further configured to: evaluate a plurality of surgical devices associated with the surgical procedure according to a hierarchy of priority; determine a cooperative schedule based on the hierarchy of priority.

[0131] Example 7: The system of any one of Examples 1-6, wherein the control circuit is further configured to: determine that a first surgical device is associated with a critical health function; prohibit activation of all other devices during a communication transmission from the first surgical device.

[0132] Example 8: The system of any one of Examples 1-7, wherein the trigger event is associated with a change in force exhibited on tissue, and wherein the tissue is being retracted. [0133] Example 9: The system of any one of Examples 1-8, wherein the response generates a virtual element to display on the AR device.

[0134] Example 10: The system of Example 9, wherein a change in force is determined based on exceeding a predetermine tissue tension.

[0135] Example 11 : The system of Example 9, wherein the surgical hub generates a virtual element to display on the AR device, and wherein the virtual element provides monitoring information for retracted tissue.

[0136] Example 12: The system of Example 11 , wherein the virtual element is anchored to the retracted tissue.

[0137] Example 13: A method for managing surgical device interaction during a surgical procedure, the method comprising: determining, by a surgical hub, contextual parameters from a surgical environment; determining, by the surgical hub, a specific surgical procedure being performed in an operating room based on the contextual parameters; receiving, by the surgical hub, procedural data from a remote server, wherein the procedural data indicates steps and surgical instruments associated with the specific surgical procedure; determining, by the surgical hub, that a trigger event is anticipated based on the procedural data and the contextual parameters; and initiating, by the surgical hub, a response according to the surgical instruments and the procedural data.

[0138] Example 14: The method of Example 13, further comprising: determining, by the surgical hub, a current procedural step of the surgical procedure, wherein the current procedural step activates a first surgical device; determining, by the surgical hub, that that the first surgical device is anticipated to interfere a communication of a second surgical device; notifying, by the surgical hub, the second surgical device of the anticipated interference; enabling, by the surgical hub, an interference defense on the second surgical device.

[0139] Example 15: The method of Example 14, wherein the interference defense is a frequency shifting protocol configured to shift from a communication signal outside of an anticipated interference frequency band.

[0140] Example 16: The method of any one of Examples 13-15, further comprising: determining, by the surgical hub, a current procedural step of the surgical procedure, wherein the current procedural step activates a first surgical device; determining, by the surgical hub, that that the first surgical device is anticipated to interfere a communication of a second surgical device; determining, by the surgical hub, that the first surgical device and the second surgical device are operable in a cooperative schedule.

[0141] Example 17: The method of Example 16, further comprising: activing, by the surgical hub, the first surgical device; and in response to completing first surgical device activation, initiating, by the surgical hub, a communication of the second surgical device.

[0142] Example 18: The method of any one of Examples 13-17, wherein the trigger event is associated with a change in force exhibited on tissue, and wherein the tissue is being retracted. [0143] Example 19: The method of Example 18, wherein the change in force is determined based on exceeding a predetermine tissue tension.

[0144] Example 20: The method of Example 18, wherein the surgical hub generates a virtual element to display on an augmented reality (AR) device, and wherein the virtual element provides monitoring information for retracted tissue.

[0145] While several forms have been illustrated and described, it is not the intention of Applicant to restrict or limit the scope of the appended claims to such detail. Numerous modifications, variations, changes, substitutions, combinations, and equivalents to those forms may be implemented and will occur to those skilled in the art without departing from the scope of the present disclosure. Moreover, the structure of each element associated with the described forms can be alternatively described as a means for providing the function performed by the element. Also, where materials are disclosed for certain components, other materials may be used. It is therefore to be understood that the foregoing description and the appended claims are intended to cover all such modifications, combinations, and variations as falling within the scope of the disclosed forms. The appended claims are intended to cover all such modifications, variations, changes, substitutions, modifications, and equivalents.

[0146] The foregoing detailed description has set forth various forms of the devices and/or processes via the use of block diagrams, flowcharts, and/or examples. Insofar as such block diagrams, flowcharts, and/or examples contain one or more functions and/or operations, it will be understood by those within the art that each function and/or operation within such block diagrams, flowcharts, and/or examples can be implemented, individually and/or collectively, by a wide range of hardware, software, firmware, or virtually any combination thereof. Those skilled in the art will recognize that some aspects of the forms disclosed herein, in whole or in part, can be equivalently implemented in integrated circuits, as one or more computer programs running on one or more computers (e.g., as one or more programs running on one or more computer systems), as one or more programs running on one or more processors (e.g., as one or more programs running on one or more microprocessors), as firmware, or as virtually any combination thereof, and that designing the circuitry and/or writing the code for the software and or firmware would be well within the skill of one of skill in the art in light of this disclosure. In addition, those skilled in the art will appreciate that the mechanisms of the subject matter described herein are capable of being distributed as one or more program products in a variety of forms, and that an illustrative form of the subject matter described herein applies regardless of the particular type of signal bearing medium used to actually carry out the distribution.

[0147] Instructions used to program logic to perform various disclosed aspects can be stored within a memory in the system, such as dynamic random access memory (DRAM), cache, flash memory, or other storage. Furthermore, the instructions can be distributed via a network or by way of other computer readable media. Thus a machine-readable medium may include any mechanism for storing or transmitting information in a form readable by a machine (e.g., a computer), but is not limited to, floppy diskettes, optical disks, compact disc, read-only memory (CD-ROMs), and magneto-optical disks, read-only memory (ROMs), random access memory (RAM), erasable programmable read-only memory (EPROM), electrically erasable programmable read-only memory (EEPROM), magnetic or optical cards, flash memory, or a tangible, machine-readable storage used in the transmission of information over the Internet via electrical, optical, acoustical or other forms of propagated signals (e.g., carrier waves, infrared signals, digital signals, etc.). Accordingly, the non-transitory computer-readable medium includes any type of tangible machine-readable medium suitable for storing or transmitting electronic instructions or information in a form readable by a machine (e.g., a computer). [0148] As used in any aspect herein, the term “control circuit” may refer to, for example, hardwired circuitry, programmable circuitry (e.g., a computer processor including one or more individual instruction processing cores, processing unit, processor, microcontroller, microcontroller unit, controller, digital signal processor (DSP), programmable logic device (PLD), programmable logic array (PLA), or field programmable gate array (FPGA)), state machine circuitry, firmware that stores instructions executed by programmable circuitry, and any combination thereof. The control circuit may, collectively or individually, be embodied as circuitry that forms part of a larger system, for example, an integrated circuit (IC), an application-specific integrated circuit (ASIC), a system on-chip (SoC), desktop computers, laptop computers, tablet computers, servers, smart phones, etc. Accordingly, as used herein “control circuit” includes, but is not limited to, electrical circuitry having at least one discrete electrical circuit, electrical circuitry having at least one integrated circuit, electrical circuitry having at least one application specific integrated circuit, electrical circuitry forming a general purpose computing device configured by a computer program (e.g., a general purpose computer configured by a computer program which at least partially carries out processes and/or devices described herein, or a microprocessor configured by a computer program which at least partially carries out processes and/or devices described herein), electrical circuitry forming a memory device (e.g., forms of random access memory), and/or electrical circuitry forming a communications device (e.g., a modem, communications switch, or optical-electrical equipment). Those having skill in the art will recognize that the subject matter described herein may be implemented in an analog or digital fashion or some combination thereof.

[0149] As used in any aspect herein, the term “logic” may refer to an app, software, firmware and/or circuitry configured to perform any of the aforementioned operations. Software may be embodied as a software package, code, instructions, instruction sets and/or data recorded on non-transitory computer readable storage medium. Firmware may be embodied as code, instructions or instruction sets and/or data that are hard-coded (e.g., nonvolatile) in memory devices.

[0150] As used in any aspect herein, the terms “component,” “system,” “module” and the like can refer to a control circuit computer-related entity, either hardware, a combination of hardware and software, software, or software in execution.

[0151] As used in any aspect herein, an “algorithm” refers to a self-consistent sequence of steps leading to a desired result, where a “step” refers to a manipulation of physical quantities and/or logic states which may, though need not necessarily, take the form of electrical or magnetic signals capable of being stored, transferred, combined, compared, and otherwise manipulated. It is common usage to refer to these signals as bits, values, elements, symbols, characters, terms, numbers, or the like. These and similar terms may be associated with the appropriate physical quantities and are merely convenient labels applied to these quantities and/or states.

[0152] A network may include a packet switched network. The communication devices may be capable of communicating with each other using a selected packet switched network communications protocol. One example communications protocol may include an Ethernet communications protocol which may be capable permitting communication using a Transmission Control Protocol/Internet Protocol (TCP/IP). The Ethernet protocol may comply or be compatible with the Ethernet standard published by the Institute of Electrical and Electronics Engineers (IEEE) titled “IEEE 802.3 Standard”, published in December, 2008 and/or later versions of this standard. Alternatively or additionally, the communication devices may be capable of communicating with each other using an X.25 communications protocol. The X.25 communications protocol may comply or be compatible with a standard promulgated by the International Telecommunication Union-Telecommunication Standardization Sector (ITU-T). Alternatively or additionally, the communication devices may be capable of communicating with each other using a frame relay communications protocol. The frame relay communications protocol may comply or be compatible with a standard promulgated by Consultative Committee for International Telegraph and Telephone (CCITT) and/or the American National Standards Institute (ANSI). Alternatively or additionally, the transceivers may be capable of communicating with each other using an Asynchronous Transfer Mode (ATM) communications protocol. The ATM communications protocol may comply or be compatible with an ATM standard published by the ATM Forum titled “ATM-MPLS Network Interworking 2.0” published August 2001 , and/or later versions of this standard. Of course, different and/or after-developed connection-oriented network communication protocols are equally contemplated herein.

[0153] Unless specifically stated otherwise as apparent from the foregoing disclosure, it is appreciated that, throughout the foregoing disclosure, discussions using terms such as “processing,” “computing,” “calculating,” “determining,” “displaying,” or the like, refer to the action and processes of a computer system, or similar electronic computing device, that manipulates and transforms data represented as physical (electronic) quantities within the computer system's registers and memories into other data similarly represented as physical quantities within the computer system memories or registers or other such information storage, transmission or display devices.

[0154] One or more components may be referred to herein as “configured to,” “configurable to,” “operable/operative to,” “adapted/adaptable,” “able to,” “conformable/conformed to,” etc. Those skilled in the art will recognize that “configured to” can generally encompass active-state components and/or inactive-state components and/or standby-state components, unless context requires otherwise.

[0155] The terms “proximal” and “distal” are used herein with reference to a clinician manipulating the handle portion of the surgical instrument. The term “proximal” refers to the portion closest to the clinician and the term “distal” refers to the portion located away from the clinician. It will be further appreciated that, for convenience and clarity, spatial terms such as “vertical”, “horizontal”, “up”, and “down” may be used herein with respect to the drawings. However, surgical instruments are used in many orientations and positions, and these terms are not intended to be limiting and/or absolute.

[0156] Those skilled in the art will recognize that, in general, terms used herein, and especially in the appended claims (e.g., bodies of the appended claims) are generally intended as “open” terms (e.g., the term “including” should be interpreted as “including but not limited to,” the term “having” should be interpreted as “having at least,” the term “includes” should be interpreted as “includes but is not limited to,” etc.). It will be further understood by those within the art that if a specific number of an introduced claim recitation is intended, such an intent will be explicitly recited in the claim, and in the absence of such recitation no such intent is present. For example, as an aid to understanding, the following appended claims may contain usage of the introductory phrases “at least one” and “one or more” to introduce claim recitations.

However, the use of such phrases should not be construed to imply that the introduction of a claim recitation by the indefinite articles “a” or “an” limits any particular claim containing such introduced claim recitation to claims containing only one such recitation, even when the same claim includes the introductory phrases “one or more” or “at least one” and indefinite articles such as “a” or “an” (e.g., “a” and/or “an” should typically be interpreted to mean “at least one” or “one or more”); the same holds true for the use of definite articles used to introduce claim recitations.

[0157] In addition, even if a specific number of an introduced claim recitation is explicitly recited, those skilled in the art will recognize that such recitation should typically be interpreted to mean at least the recited number (e.g., the bare recitation of “two recitations,” without other modifiers, typically means at least two recitations, or two or more recitations). Furthermore, in those instances where a convention analogous to “at least one of A, B, and C, etc.” is used, in general such a construction is intended in the sense one having skill in the art would understand the convention (e.g., “a system having at least one of A, B, and C” would include but not be limited to systems that have A alone, B alone, C alone, A and B together, A and C together, B and C together, and/or A, B, and C together, etc.). In those instances where a convention analogous to “at least one of A, B, or C, etc.” is used, in general such a construction is intended in the sense one having skill in the art would understand the convention (e.g., “a system having at least one of A, B, or C” would include but not be limited to systems that have A alone, B alone, C alone, A and B together, A and C together, B and C together, and/or A, B, and C together, etc.). It will be further understood by those within the art that typically a disjunctive word and/or phrase presenting two or more alternative terms, whether in the description, claims, or drawings, should be understood to contemplate the possibilities of including one of the terms, either of the terms, or both terms unless context dictates otherwise. For example, the phrase “A or B” will be typically understood to include the possibilities of “A” or “B” or “A and B.”

[0158] With respect to the appended claims, those skilled in the art will appreciate that recited operations therein may generally be performed in any order. Also, although various operational flow diagrams are presented in a sequence(s), it should be understood that the various operations may be performed in other orders than those which are illustrated, or may be performed concurrently. Examples of such alternate orderings may include overlapping, interleaved, interrupted, reordered, incremental, preparatory, supplemental, simultaneous, reverse, or other variant orderings, unless context dictates otherwise. Furthermore, terms like “responsive to,” “related to,” or other past-tense adjectives are generally not intended to exclude such variants, unless context dictates otherwise.

[0159] It is worthy to note that any reference to “one aspect,” “an aspect,” “an exemplification,” “one exemplification,” and the like means that a particular feature, structure, or characteristic described in connection with the aspect is included in at least one aspect. Thus, appearances of the phrases “in one aspect,” “in an aspect,” “in an exemplification,” and “in one exemplification” in various places throughout the specification are not necessarily all referring to the same aspect. Furthermore, the particular features, structures or characteristics may be combined in any suitable manner in one or more aspects.

[0160] Any patent application, patent, non-patent publication, or other disclosure material referred to in this specification and/or listed in any Application Data Sheet is incorporated by reference herein, to the extent that the incorporated materials is not inconsistent herewith. As such, and to the extent necessary, the disclosure as explicitly set forth herein supersedes any conflicting material incorporated herein by reference. Any material, or portion thereof, that is said to be incorporated by reference herein, but which conflicts with existing definitions, statements, or other disclosure material set forth herein will only be incorporated to the extent that no conflict arises between that incorporated material and the existing disclosure material. [0161] In summary, numerous benefits have been described which result from employing the concepts described herein. The foregoing description of the one or more forms has been presented for purposes of illustration and description. It is not intended to be exhaustive or limiting to the precise form disclosed. Modifications or variations are possible in light of the above teachings. The one or more forms were chosen and described in order to illustrate principles and practical application to thereby enable one of ordinary skill in the art to utilize the various forms and with various modifications as are suited to the particular use contemplated. It is intended that the claims submitted herewith define the overall scope.

Claims

CLAIMS What is claimed is:

1. A surgical system comprises: a remote server; augmented reality (AR) output device; one or more surgical devices; a surgical hub communicatively coupled to the remote server, the one or more surgical devices, and the AR output device, the surgical hub comprises a control circuit coupled to a memory, and wherein the control circuit is configured to: determine contextual parameters from a surgical environment; determine from the contextual parameter a specific surgical procedure being performed in an operating room; receive procedural data from the remote server, wherein the procedural data indicates steps and surgical instruments associated with the specific surgical procedure; determine that a trigger event is anticipated based on the procedural data and the contextual parameters. initiate a response to the anticipated trigger event according to the surgical instruments and procedural data.

2. The system of claim 1 , wherein the control circuit is further configured to: determine a current procedural step of the surgical procedure, wherein the current procedural step activates a first surgical device; determine that that the first surgical device is anticipated to interfere in a communication of a second surgical device; notify the second surgical device of the anticipated interference; enable an interference defense on the second surgical device.

3. The system of claim 2, wherein the interference defense is a frequency shifting protocol configured to shift from a communication signal outside of an anticipated interference frequency band.

4. The system of claim 1 , wherein the control circuit is further configured to: determine a current procedural step of the surgical procedure, wherein the current procedural step activates a first surgical device; determine that that the first surgical device is anticipated to interfere the communication of a second surgical device; determine that the first surgical device and the second surgical device are operable in a cooperative schedule.

5. The system of claim 4, wherein the control circuit is further configured to: active the first surgical device; and in response to a completed first surgical device activation, initiate the communication of the second surgical device.

6. The system of claim 1 , wherein the control circuit is further configured to: evaluate a plurality of surgical devices associated with the surgical procedure according to a hierarchy of priority; determine a cooperative schedule based on the hierarchy of priority.

7. The system of claim 1 , wherein the control circuit is further configured to: determine that a first surgical device is associated with a critical health function; prohibit activation of all other devices during a communication transmission from the first surgical device.

8. The system of claim 1 , wherein the trigger event is associated with a change in force exhibited on tissue, and wherein the tissue is being retracted.

9. The system of claim 1 , wherein the response generates a virtual element to display on the AR device.

10. The system of claim 9, wherein a change in force is determined based on exceeding a predetermine tissue tension.

11 . The system of claim 9, wherein the surgical hub generates a virtual element to display on the AR device, and wherein the virtual element provides monitoring information for retracted tissue.

12. The system of claim 11 , wherein the virtual element is anchored to the retracted tissue.

13. A method for managing surgical device interaction during a surgical procedure, the method comprising: determining, by a surgical hub, contextual parameters from a surgical environment; determining, by the surgical hub, a specific surgical procedure being performed in an operating room based on the contextual parameters; receiving, by the surgical hub, procedural data from a remote server, wherein the procedural data indicates steps and surgical instruments associated with the specific surgical procedure; determining, by the surgical hub, that a trigger event is anticipated based on the procedural data and the contextual parameters; and initiating, by the surgical hub, a response according to the surgical instruments and the procedural data.

14. The method of claim 13, further comprising: determining, by the surgical hub, a current procedural step of the surgical procedure, wherein the current procedural step activates a first surgical device; determining, by the surgical hub, that that the first surgical device is anticipated to interfere a communication of a second surgical device; notifying, by the surgical hub, the second surgical device of the anticipated interference; enabling, by the surgical hub, an interference defense on the second surgical device.

15. The method of claim 14, wherein the interference defense is a frequency shifting protocol configured to shift from a communication signal outside of an anticipated interference frequency band.

16. The method of claim 13, further comprising: determining, by the surgical hub, a current procedural step of the surgical procedure, wherein the current procedural step activates a first surgical device; determining, by the surgical hub, that that the first surgical device is anticipated to interfere a communication of a second surgical device; determining, by the surgical hub, that the first surgical device and the second surgical device are operable in a cooperative schedule.

17. The method of claim 16, further comprising: activing, by the surgical hub, the first surgical device; and in response to completing first surgical device activation, initiating, by the surgical hub, a communication of the second surgical device.

18. The method of claim 13, wherein the trigger event is associated with a change in force exhibited on tissue, and wherein the tissue is being retracted.

19. The method of claim 18, wherein the change in force is determined based on exceeding a predetermine tissue tension.

20. The method of claim 18, wherein the surgical hub generates a virtual element to display on an augmented reality (AR) device, and wherein the virtual element provides monitoring information for retracted tissue.